Pregnancy and Breastfeeding medications CI

Question 1

what sorts of drugs are LESS likely to cross from the maternal blood to the baby via breastmilk?

Answer 1

drugs that are highly bound to plasma proteins in the mother’s blood will be less able to transfer to milk

Question 2

what are some general practice points for prescribing medications to lactating women?

Answer 2

1. determine if the drug is absorbed via GIT as may be poorly absorbed by infant’s GIT
2. compare amount absorbed to a paediatric dose
3. choose shorter half life drugs!
4. choose drugs with high protein binding!
5. be careful of medications applied to the nipple

Question 3

a breastfeeding mother needs to take a radioactive compound/drug (e.g. for cancer). what might you advise her in terms of breastfeeding?

Answer 3

wait at least 4-5 half lives before breastfeeding. After 5 half-lives, 98% of the drug will be eliminated.

Question 4

if a pregnant woman is at high risk of clotting, why can’t warfarin be used? what do we use instead? what about during breastfeeding?

Answer 4

Warfarin crosses the placenta, and may produce chondrodystrophy, optic atrophy and haemorrhagic problems in the fetus. Insertion of an inferior vena cava filter is reserved for those women with repeated emboli despite anticoagulation, or women with a contraindication to anticoagulation.

but typically we use low molecular weight heparin.

recommence warfarin in the postpartum period because does not pass into breastmilk